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Differential Diagnosis

The two types of lesions that most often must be differentiated from periapical inflammatory lesions are periapical osseous dysplasia (POD) and a dense bone island (DBI) (enostosis, osteosclerosis) at the apex of a tooth. In the early radiolucent phase of POD, the imaging characteristics may not reliably differentiate this lesion from a periapical inflammatory lesion. The diagnosis may rely solely on the clinical examination, including a test of tooth vitality.

Two early lesions of periapical osseous dysplasia related to the apical region of the mandibular central incisors; note the similarity to apical rarefying osteitis.

Radiolucent apical scar after successful endodontic treatment. B, Healing periapical inflammatory lesion (arrow) associated with the apical region of a maxillary lateral incisor. Note the radiating, spokelike pattern of new bone forming from the periphery of the lesion

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